If you want to protect yourself from an infection with the HI virus, you can do this not only with condoms, but also with the so-called pre-exposure prophylaxis, or prep for short. However, the combination of drugs prevents HIV infection as well as condoms, but it does not prevent other sexually transmitted diseases. Doctors diagnosed gonorrhea, chlamydia, or syphilis in almost three quarters of patients using Prep within the first year of use. This is what researchers led by Jason Ong from the London School of Hygiene and Tropical Medicine in London are now reporting in the journal "Jama Network Open".
The scientists around Ong, including employees of the World Health Organization (WHO), had evaluated 88 studies from five continents on the use of Prep. While gonorrhea, chlamydia or syphilis were diagnosed in 23.9 percent of the patients at the initial examination, the number of diseases rose to 72.2 percent within the first year of using Prep.
For a long time, experts have feared that the prep drugs could tempt users to use condoms less often - and this increases their risk of becoming infected with other sexually transmitted diseases. According to the German-Austrian guidelines, Prep is suitable for different groups of people.
More than 7000 syphilis diseases in Germany every year
The figures published by the Robert Koch Institute (RKI) a few days ago show that sexually transmitted diseases should not be neglected in this country either: in 2018, the number of new syphilis cases in Germany was 7232 cases, a level similar to the previous year. The infectious disease caused by bacteria can be cured by antibiotics, but if left untreated there is a risk of long-term damage to the brain and blood vessels. According to the RKI, the risk of infection differs in the federal states: There were 32.5 cases per 100,000 inhabitants in Berlin, and only 4.3 in Thuringia. The national average was 8.8 people affected per 100,000 inhabitants.
For Armin Schafberger from Deutsche Aidshilfe in Berlin, the figures from the current prep study are not surprising. However, he points out that the study does not take into account the type and scope of the medical examinations and diagnoses. This can be seen, for example, in the fact that gonorrhea, chlamydia and syphilis were detected much more frequently in countries with high average incomes than in countries with low or medium average incomes. A conceivable reason: In rich nations, those who do not have any symptoms are often examined for diseases. "If you take a closer look, you will find more," emphasizes Schafberger.
Similar studies - albeit with less data - with comparable results have already existed, said Schafberger. He had actually hoped from the current analysis that the data would be used to provide clear recommendations for medical support for Prep. But it is still unclear whether combating infections without symptoms with antibiotics will benefit the patient more or more - for example, because the frequent use of antibiotics can lead to resistance.
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Schafberger also sees something positive in the high number of diagnoses: "They show that prep treatment can actually be used to reach those groups who have a high risk of sexually transmitted diseases." This is a good opportunity for preventive measures. Because during the prep treatment, the patients do not only have to be checked for HIV every three months. The German-Austrian Prep guidelines also recommend tests for hepatitis C (every six to twelve months), syphilis (every three months), gonorrhea (every three to six months) and chlamydia (every three to six months).